Evaluation of autologous plasma skin test in patients with chronic idiopathic urticaria.

BACKGROUND: The pathophysiological mechanism of chronic urticaria is still poorly understood and its aetiology is considered to have an autoreactive basis. Autologous serum skin tests (ASSTs) and autologous plasma skin tests (APSTs) comprise the simplest ways for diagnosing autoreactive urticaria (with autoantibodies, histamine-releasing factor and coagulation factors, especially thrombin) in a clinical setting. However, there are still some questions about the specificity of these tests. OBJECTIVES: To evaluate the role of autoreactivity in the pathogenesis of chronic urticaria by means of measuring plasma prothrombin fragments 1 + 2, which are used as markers of thrombin, and to compare the APST with the ASST. METHODS: Forty-two patients (19 men and 23 women; mean age 35·7 years, range 28-76) and 35 healthy volunteers (19 men and 16 women; mean age 30·3 years, range 20-80) were included in the study. APST, negative (ASST, sodium citrate, saline) and positive (histamine) control tests were performed in the patient and control groups. The levels of plasma prothrombin fragments 1 + 2 were also assessed. RESULTS: When the APST was evaluated without negative controls, it was positive in 67% of patients. However, the APST was positive in 0% when it was evaluated with negative controls. Levels of prothrombin fragments 1 + 2 were found to be elevated in patients with chronic idiopathic urticaria. CONCLUSIONS: We suggest that as negative control tests were not performed along with the APST in previous studies, the APST showed a high rate of positivity. Thus, the use of APST for evaluating autoreactivity in clinical practice is not superior to the use of ASST and further studies should be conducted.

Oesophageal aspergillosis in a case of acute lymphoblastic leukaemia successfully treated with caspofungin alone due to liposomal amphotericin B induced severe hepatotoxicity.

Aspergillosis is one of the most common invasive fungal infections in immunocompromised patients. Sinonasal region and upper respiratory tract are commonly involved regions whereas oesophagus is seldom involved. We present an 18-year-old male with acute lymphoblastic leukaemia with aspergillosis of oesophagus which is a rare region of involvement. The diagnosis was confirmed by the examination of the cultures of endoscopic biopsy material. The patient was already receiving empirical liposomal amphotericin B, due to severe hepatotoxicity the therapy was switched to another antifungal (caspofungin). Here we report a case of successful treatment of invasive oesophageal aspergillosis by caspofungin.

Evaluation of autologous serum skin test results in patients with chronic idiopathic urticaria, allergic/non-allergic asthma or rhinitis and healthy people.

BACKGROUND: Recent data indicate that the autologous serum skin test (ASST) shows a high rate of reactivity not only in chronic idiopathic urticaria (CIU) but also in cases with non-allergic asthma and rhinitis (NAAR), multiple drug allergy syndrome (MDAS) and even in some healthy people. Aim. To evaluate ASST reactivity in patients with CIU, allergic/non-allergic asthma or rhinitis and in healthy controls. METHODS: We studied 80 patients with CIU, 40 non-atopic patients with NAAR, 57 patients with allergic rhinitis (AR) and allergic bronchial asthma (ABA), and 45 healthy controls. ASST was performed in all patients and controls, and it was considered positive when a serum-induced weal with a diameter 1.5 mm greater than the negative (saline) control, surrounded by erythema, was present. RESULTS: In total, 42 patients with CIU showed ASST reactivity (52.5%). ASST was found to be positive in 8 of 40 patients with NAAR (20%). The rate was similar (17.5%) in the AR/ABA patient group. However, 25 healthy controls (55.5%) also had positive ASST. The highest rate was in female controls and in individuals in the 18-30-year-old age group. CONCLUSION: The data indicate that ASST positivity might be a nonspecific phenomenon, influenced by many factors. In the light of the results of this study, we suggest that the significance of ASST reactivity should be re-evaluated in CIU. In addition, the importance of ASST reactivity in patients with AR/ABA and in patients with NAAR remains unclear, and further controlled studies are needed.

Necrotizing fasciitis: A life-threatening clinical disorder in uncontrolled type 2 diabetic patients.

We presented 23 patients with necrotizing fasciitis (NF), 15 of whom had uncontrolled diabetes mellitus (DM), for risk factors, clinical signs, laboratory findings and prognosis during the period 1998 and 2006 in Istanbul. A hospital incidence of NF was 14.2/100,000 admissions. Other risk factors were obesity in 9 and recent surgical trauma in 10 patients. The mean age of the patients with DM was higher than that of the patients with non-DM (58.6+/-12.8 vs 43.0+/-17.2 years, p=0.028). The most frequently isolated microorganisms from tissue cultures were Escherichia coli, Klebsiella pneumoniae and Group A streptococci. Of the 23 patients, 9 (39%), of whom 8 had DM, died between 2 and 29 days after admission. The mortality rate and length of hospitalization were longer in diabetic patients than in others (p=0.02 and p=0.286, respectively). The mean blood glucose levels and HbA1C were higher in non-survival group than in survival group (195.6+/-41.5 vs 133.7+/-22.1 and 10.6 vs 7.4) (p=0.04, r=0.39 and p=0.03, r=0.50, respectively). In the univariate analysis, the hospitalization time (r=0.72), white blood cell count (r=0.52) and surgical debridement count (r=0.47) were found to be prognostic risk factors. Our results showed that NF is a very serious life-threatening disorder in especially diabetic patients with bad metabolic control.